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cardiopulmonary exam 3 > PE for heart diseases > Flashcards

PE for heart diseases Flashcards

1
Q

common historical findings

A 
Asymptomatic
non-specific signs: lethargy, anorexia, weight loss, failure to thrive, withdrawn
exercise intolerance
respiratory distress
coughing-at rest, during the night
abdominal distension
syncope
sudden death
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2
Q

syncope

A

brief duration-sudden onset, quick recovery
flaccid or rigid
no muscle movement
pale or blue MM color
urination
may cry at onset
often triggered by activity or excitement

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3
Q

seizure

A 
three phases: pre/ictal/post
muscle movements throughout
continual vocalizing
urination
defecation
hyperthermia
pink MM color
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4
Q

hands off examination

A 
attitude, awareness, demeanor
respiratory rate & effort
coughing
BCS
cardiac cachexia
abdominal distension
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5
Q

when cough is harsh and honking?

A

airway collapse

associated with excitement

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6
Q

when a cough is soft and quiet?

A

fluid in airways

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7
Q

where will you see cardiac cachexia most prominently?

A

spine and temporal region of head

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8
Q

What will the mucous membranes tell you?

A

capillary refill time (>2 seconds)=poor perfusion and peripheral vasoconstriction
hydration status
color

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9
Q

cyanosis

A

decreased oxygen bound to hemoglobin

caused by environment, pulmonary disease, right to left shunts

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10
Q

central cyanosis

A

intracardiac shunts
pulmonary disease
ex: tongue is blue

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11
Q

differential cyanosis

A

ex: MM of mouth=normal, MM of penis-cyanotic

reversed patent ductus arteriosus

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12
Q

normal jugular veins

A

non-distended
empty quickly following compression
pulsations less than 1/3 of neck

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13
Q

abnormal jugular veins

A

increased central venous pressure
pericardial effusion
caval obstruction
third degree AV block-cannon waves

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14
Q

tracheal palpation

A

how easy is it to elicit a cough?

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15
Q

auscultation approach

A 
palpate for apex beat or thrill
auscultate both sides of chest
rhythm and rate analyssi
listen to each valve area
identify all sounds
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16
Q

apex beat

A

low frequency vibration on thoracic wall
contraction and rotation of heart
synchronous with early systole (S1 sound)
start place for auscultation-mitral valve location
strength not useful assessment

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17
Q

location of apex beat

A

normal: left side at 5th ICS, CC junction

abnormal-right side-right side enlargement, caudal=cranial mediastinal mass

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18
Q

where should you listen to a cat on auscultation?

A

sternal, right and left parasternal regions

most murmurs are heard at 4-5th ICS over or just to the right or left of the sternum

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19
Q

where should you listen to a dog on auscultation?

A

left axillary region-cranial dorsal to pulmonic valve region, murmur of PDA
right cranial region-2nd to 3rd ICS, murmurs often radiate to this region (aortic stenosis)

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20
Q

bradycardia in dogs

A

<60 bpm

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21
Q

tachycardia in dogs

A

> 160 bpm

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22
Q

bradycardia in cats

A

<100 bpm

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23
Q

tachycardia in cats

A

> 240 bpm

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24
Q

cyclical, associated with respiration heart rhythm

A

sinus arrhythmia

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25
Q

premature beat (heart rhythm)

A

often followed by a short pause (cats)
extrasystoles
sounds like tripping

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26
Q

pause or dropped beat (heart rhythm)

A

sinus arrest, second degree AV block

not associated with respiration

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27
Q

chaotic (heart rhythm)

A

atrial fibrillation

ventricular arrhythmias

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28
Q

paroxysmal (heart rhythm)

A

sudden onset and offset of arrhythmia

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29
Q

S1 sound represents?

A 
closure of atrioventrical valves
during QRS complex
S1 loudest over mitral valve
low frequency
lub sounds
30
Q

S2 sound represents?

A

closure of semilunar valves
after T wave
loudest over pulmonic or aortic valves
dub sound

31
Q

Absent S2 sound?

A

occurs with pulse deficit

32
Q

muffled heart sound

A

pericardial or pleural effusion

pneumothorax

33
Q

S3 sound

A

early diastolic sound
immediately after S2
rapid ventricular filling
SAM: dilated cardiomyopathy (Dogs)

34
Q

S4 sound

A

late diastolic sounds (preceeds S1)
atrial contraction
SAM: hypertrophic cardiomyopathy (cats)

35
Q

characteristics of S3 and S4

A 
left apical location
dull low intensity-buh sound
3 sounds-horse galloping
normal in LA
abnormal in SAM=heart disease
36
Q

systolic clicks

A

short to mid-high frequency sounds
occur in mid to late systole
heard over mitral and/or tricuspid valves
result of prolapse of valvular leaflets during systole
transient sound quickly replaced by murmur of valvular regurgitation

37
Q

split S2 heart sound

A

delay closure of the aortic or pulmonary valves-asynchrony

causes: normal, bundle branch blocks, pulmonary hypertension (common)

38
Q

abnormal heart sounds: Educated guesses?

A

cats-almost always a gallop sound
puppies: split S2 sound
adult dogs: systolic clicks most likely, split S2 esp in large breed dogs

39
Q

cardiac murmur classification

A

timing: systolic, diastolic, or continuous
localization?
intensity (grade 1-6)
duration (early, holo, or pan-)
shape: plateau, diamond, crescendo or decrescendo

40
Q

plateau shaped murmur

A

mitral or tricupsid valve pathology

41
Q

diamond shaped murmur

A

stenosis of aortic or pulmonary vessels

42
Q

grade 1 murmur

A

very soft murmur detected after very careful auscultation

43
Q

grade 2 murmur

A

soft murmur that is readily evident

44
Q

grade 3 murmur

A

moderately intense murmur that is still focal

45
Q

grade 4 murmur

A

loud murmur that widely radiates over thorax, no thrill

46
Q

grade 5 murmur

A

murmur associated with a palpable precordial thrill

not audible when the stethoscope is lifted from the thoracic body wall

47
Q

grade 6 murmur

A

audible even when stethoscope is lifted from thoracic wall

48
Q

murmur intensity

A

poorly correlated with disease severity
factors affecting intensity: environment, stethoscope type, thoracic conformation, blood viscosity, state of contractility, cardiac output, pressure gradient, direction of flow/insufficiency, volume of flow/insufficiency

49
Q

physiologic flow murmurs

A

not associated with CV disease
seen with puppies <5 months of age, increased CO (fever), decreased blood viscosity
characteristics: systolic, heart base location, intensity 3/6 or less

50
Q

dx of physiologic flow murmurs

A

no evidence of CV disease (normal thoracic rads & echo)
patient signalment
identify etiology
murmur characteristics

51
Q

pathologic murmur types

A

secondary to CV disease

associated with abnormal valves, shunts, vessel diameter

52
Q

characteristics of pathologic murmurs

A

any timing
any location
any intensity
any age

53
Q

left sided: mitral regurgitation murmur

A

most common murmur

congenital or acquired diseases (valvular dysplasia, degenerative valve disease, cardiomyopathy, endocarditis)

54
Q

characteristics of left side: mitral regurgitation murmur

A

holo or pansystolic
plateau shaped
PMI over left apex: 5th ICS at CC junction, Cats-left parasternum
may radiate toward right or cranially (if >4/6)
coarse or honking

55
Q

left sided semilunar valve stenosis murmur

A

congenital disease: aortic/pulmonary stenosis

relative pulmonic stenosis (excessive blood flow)

56
Q

left sided semilunar valve stenosis murmur characteristics

A

diamond shape
PMI: cranial dorsal to apex beat (3-4th ICS)
often radiated to right cranial region
aortic murmur may also radiate up neck through carotid arteries

57
Q

right sided tricupsid regurgitation murmur etiology

A

valvular dysplasia, degenerative valve disease, cardiomyopathy, endocarditis

58
Q

right sided tricupsid regurgitation murmur characteristics

A

holo- or pansystolic
plateua shaped
PMI: right 3-4th ICS
radiate dorsally

59
Q

right sided ventricular septal defect murmur characteristics

A

pansystolic
PMI: right 3-4 ICS
young animal

60
Q

right cranial murmurs

A

aortic stenosis or pulmonic stenosis

61
Q

semilunar valve insufficiency murmur

A

diastolic
etiology: aortic insufficiency (endocarditis, degenerative valve disease, dysplasia), pulmonic insufficiency (pulmonary hypertension, valvular dysplasia)

62
Q

semilunar valve insufficiency murmur characteristics

A

early-holodiastolic (begins with S2 heart sound, don’t heart S2)
left sided
variable intensity
decrescendo shape

63
Q

continuous murmur

A

murmur of patent ductus arteriosus
left basilar location (often focal)
typically loud (>3/6)

64
Q

to and fro murmur

A

systolic and diastolic components (pause between systolic and diastolic components)
associated with semilunar stenosis and insufficiency
left basilar location

65
Q

crackles

A

series of short bursts of sounds originating in parenchyma or airways
produced by sudden opening of previously collapsed airways or rupture of fluid films or bubbles
typically heard on inspiration
located in ventral pulmonary fields

66
Q

abdominal palpation

A

right side congestive heart failure: ascites (fluid wave), hepatomegaly, hepatojugular reflux
ventricular arrhythmias commonly caused by abdominal neoplasia (spleen and liver)

67
Q

arterial pulse

A

assess rate, rhythm and strength

rate and rhythm abnormalities: pulse deficits, arrhythmias

68
Q

pulse strength

A

difference between systolic and diastolic pressures

rough estimate of stroke volume

69
Q

hypokinetic pulses

A 
tachycardia
decreased ventricular contractility
hypovolemia
pericardial effusion
shock
subaortic stenosis
70
Q

hyperkinetic pulses

A

anemia
bradycardia
aortic insufficiency
patent ductus arteriosis

71
Q

varying pulse strength

A

paraxodus: pericardial effusion
alternans: cardiomyopathy, arrhythmias
variable pulse strength-arrhythmias

cardiopulmonary exam 3 (7 decks)

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